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DOUGLAS A CLARK MD PC
NPI 1780952259
Orthopaedic Surgery in Tempe, AZ

Active since December 12, 2011
2055 E SOUTHERN AVE, SUITE G, TEMPE, AZ 85282(480) 839-0008(480) 838-3333 Get Directions Write a Review

NPPES record last updated: December 12, 2011. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Douglas A Clark Md Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DOUGLAS A CLARK MD PC (NPI 1780952259) is a healthcare organization registered as an orthopaedic surgery in Tempe, Arizona and active in the NPI registry since December 2011. The organization lists Douglas A Clark, Owner, as its authorized official.

NPPES Registry Identity

NPI1780952259
Entity TypeOrganization
Primary Taxonomy207X00000X
Legal Business NameDOUGLAS A CLARK MD PC
Location Address2055 E SOUTHERN AVE, SUITE GTempe, AZ 85282-7507
Mailing Address2055 E Southern Ave, Suite GTempe, AZ 85282-7507 · (480) 839-0008 · Fax (480) 838-3333
Phone(480) 839-0008
Fax(480) 838-3333
Organization SubpartNo
Authorized OfficialDouglas A ClarkOwner · (480) 839-0008
Enumeration DateDecember 12, 2011
✔ NPI 1780952259 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOrthopaedic SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207X00000X
License✔ Licensed in AZ · 14762
Definition
An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.
2055 E SOUTHERN AVE, Tempe, AZ 85282
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Other Identifiers 1

Medicare UPIND43782AZ

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Douglas A Clark Md Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by March 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateArizonaEnrollment IDO20120526000024Non-DME Part B · Clinic/Group PracticeDue dateMarch 31, 2027
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Douglas A Clark MD PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Douglas Clark, MD
Orthopedic Surgery
NPI 1396892907
2055 E SOUTHERN AVE SUITE G
Tempe, AZ 85282
(480) 839-0008
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Douglas A Clark MD PC's NPI number?

The NPI number for Douglas A Clark MD PC is 1780952259. It was assigned to this organization in the NPPES registry on December 12, 2011.

Where is Douglas A Clark MD PC located?

Douglas A Clark MD PC is located at 2055 E Southern Ave Suite G, Tempe, AZ 85282. The listed phone number is (480) 839-0008.

What is Douglas A Clark MD PC's specialty?

The primary specialty registered for this NPI is Orthopaedic Surgery with taxonomy code 207X00000X.

Is Douglas A Clark MD PC enrolled in Medicare?

Yes. Douglas A Clark MD PC is registered in the Medicare PECOS enrollment system.

When is Douglas A Clark MD PC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Arizona, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Douglas A Clark MD PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Orthopedic Surgery) reassigns their Medicare billing to Douglas A Clark MD PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Douglas A Clark MD PC was last updated on December 12, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.